| NPI | 1902881915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: CO 506) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CO 506) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CO 506) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2008-01-07 |